A cat’s cradle of reform

With numerous strokes of numerous pens on Tuesday, President Barack Obama signed health-care reform bill into law. Now, the immensely controversial and complicated measure argued over and ultimately passed by Congress will gradually come to govern the nation’s health-care system in coming years. It’s all over but the shouting. But the shouting is likely to last a long, long time and reverberate through our system of government for years to come.

In fact, this entire debate has been more about shouting and beating the other guys than it has been about rational, reasonable deliberations on health-care finance. Those who have a political stake in one side or another are absolutely certain they’re right, even if they understand precious little about the bill in its entirety. No need for that. They’re perfectly fine with getting their selected talking points from Nancy Pelosi or John Boehner, or People for the American Way or Glenn Beck.

But now, despite the jubilant cries of triumph by supporters and the howls of impending apocalypse by opponents, we’d guess that there are a lot Americans who have no idea of what the bill means for them, their families, their communities or the nation. Mystification is the appropriate response, we think.

You can count leaders of both of Staten Island’s two hospital systems among the bewildered.

Both Gary Terrinoni, Richmond University Medical Center’s chief financial officer, and Tony Ferreri, Staten Island University Hospital’s chief executive officer, said that even though health reform has been Topic A for a year and is now “the law of the land,” they’re uncertain as to how it’s going to affect their institutions.

The changes in Medicare, Medicaid, and other reimbursement protocols, as well as a myriad of other regulatory revisions — and the growing number of currently uninsured Americans who will be insured by law in coming years — are all certainly going to have an impact. But this cat’s cradle of reforms makes it difficult to ascertain what that impact will be.

Mr. Terrinoni estimates that RUMC could lose $31 million over a 10-year period with the revised reimbursement schedule for so-called disproportionate share hospitals, which handle a high percentage of uninsured and under-insured patients.

But he admitted that with the timetable for uninsured patients getting health insurance and the value of that insurance when they get it, the projections are “hard to quantify.”

New limits on Medicare and other provision of the reform package could cost RUMC tens of millions more, he said.

“It has created a lot of anxiety,” Mr. Terrinoni said. “Could we survive with those hits? It would be very difficult.”

(Rep. Michael McMahon cited the potential threat to the Island hospitals’ survival as a major reason for voting no on the health-reform measure.)

On the bright side, he said that with the changes being phased in over a multi-year time span, hospitals have the time to develop strategies to adapt to the new regimen.

Mr. Ferreri echoed that hopeful note, but otherwise confessed to being frustrated by the complexity of what he termed a “confusing” piece of legislation. He too, said it would be years before the real impact would be known.

And he made this extraordinarily candid admission: “I couldn’t tell you whether I was in favor or opposed to the bill.”

This is from a person who is the top administrator at a major, big-city hospital, who has an intimate knowledge of the hospital industry and the field of health-care financing. If he doesn’t fully understand what it means for his institution, who else can (aside from those who’ve gotten daily apocalyptic briefings from Glenn Beck, of course)? His remarkable statement tells a lot about what Congress and the president produced.

Some might be troubled by his admission, but we find the honesty refreshing. Had there been more of it in the debate, Congress might have produced a far better bill. But the health-care reform siege was always much more about who wins and loses politically than it was about getting serious about figuring out the best way to contain the runaway costs of health care. It’s not clear that such seriousness is even possible in Washington D.C. today.